Spina Bifida and Anencephaly (cont.)
How is spina bifida diagnosed?
In most cases, spina bifida is diagnosed prenatally, or
before birth. However, some mild cases may go unnoticed until after birth, or
postnatally. Very mild cases, in which there are no symptoms, may never be
detected.
Prenatal Diagnosis
The most common screening methods used to look for spina
bifida during pregnancy are second trimester maternal serum alpha fetoprotein
(MSAFP) screening and fetal ultrasound. The MSAFP screen measures the level of a
protein
called alpha-fetoprotein (AFP), which is made naturally by the fetus and
placenta. During
pregnancy, a small amount of AFP normally crosses the placenta and enters the
mother's bloodstream. But if abnormally high levels of this protein appear in
the mother's bloodstream it may indicate that the fetus has a neural tube
defect. The MSAFP test, however, is not specific for spina bifida, and the test
cannot definitively determine that there is a problem with the fetus. If a high
level of AFP is detected, the doctor may request additional testing, such as an
ultrasound or amniocentesis to help determine the cause.
The second trimester MSAFP screen described above may be
performed alone or as part of a larger, multiple-marker screen. Multiple-marker
screens look not only for neural tube defects, but also for other birth defects,
including Down syndrome and other chromosomal abnormalities. First trimester screens for
chromosomal abnormalities also exist but signs of spina bifida are not evident
until the second trimester when the MSAFP screening is performed.
Amniocentesis—an exam in which the doctor removes samples of fluid from the
amniotic sac that surrounds the fetus—may also be used to diagnose spina bifida.
Although amniocentesis cannot reveal the severity of spina bifida, finding high
levels of AFP may indicate that the disorder is present.
Postnatal Diagnosis
Mild cases of spina bifida not diagnosed during prenatal
testing may be detected postnatally by X-ray during a routine examination.
Doctors may use magnetic resonance imaging (MRI) or a computed tomography (CT)
scan to get a clearer view of the spine and vertebrae. Individuals with the more
severe forms of spina bifida often have muscle weakness in their feet, hips, and
legs. If hydrocephalus is suspected, the doctor may request a CT scan and/or
X-ray of the skull to look for extra fluid inside the brain.
Next: How is spina bifida treated? »
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